摘要： 目的：探讨下颌支矢状骨劈开术（sagittal split ramus osteotomy，SSRO）后下唇及颏部感觉功能障碍（neurosensory dysfunction,NSD）的发生区域、恢复趋势及影响因素。方法：对20例接受SSRO的骨性Ⅲ类患者，术前1周采集数据，并和术后1周、1个月、3个月、6个月随访数据对比。具体将下唇及颏部皮肤分为4个区域，检查每个区域的针刺觉、痛觉、热觉、冷觉、锐觉、钝觉、轻触觉、两点辨别觉，采用5分法记录检查结果。根据年龄、性别、神经暴露情况等因素分组，采用SPSS20.0统计学软件对数据进行处理。结果：1、2、3区域术后感觉得分均低于术前，各区域两两之间差异无统计学意义（P>0.05），区域4手术前后得分无改变。术后1周至6个月感觉得分逐渐提高，各种感觉NSD的发生率术后1周最高（92.5%~97.5%），术后6个月最低（15%~40%）。在同一时间痛觉得分最高，热觉最低。年龄、性别差异对感觉的影响无统计学意义（P>0.05）。颏成形术、神经暴露情况、远心骨段移动幅度、术后使用神经营养药物情况对感觉的影响有统计学意义（P<0.05）。结论：SSRO后NSD易发生于下唇及口角内侧的皮肤；术后痛觉的恢复优于其他感觉，热觉恢复最差；颏成形术、术中神经暴露及远心骨段大幅度移动，是术后感觉障碍的危险因素；术后使用恩经复（nerve growth factor, NGF）可促进NSD的恢复。

关键词: 下颌支矢状骨劈开术；  , 感觉障碍；  , 下牙槽神经；  , 临床研究

Abstract: Objective: The aim of this study was to investigate the accurate location, recovery process, and influence factors of neurosensory dysfunction (NSD) in the lower lip and chin after sagittal split ramus osteotomy(SSRO). Methods: 20 patients with skeletal Class Ⅲ malocclusion undergone SSRO were examined at 1-week before the surgery， and 1-week, 1-month, 3-month, 6-month after the surgery. The surface skin in the lower lip and chin was divided into 4 zones. Neurosensory function of each zone was measured by tests， consisting of pinprick discrimination, algesia discrimination, warm/cold discrimination, sharp/blunt discrimination, light touch test, 2-point discrimination. The results were recorded by 5-point method. Patients were divided into 2 groups in accordance with  age, gender, and the exposure of inferior alveolar nerve (IAN) repectively. Statistical analysis was performed using the SPSS 20.0 software package. Results: The sensory score of zone 1, zone 2,  and zone 3 postoperation was lower than the score before operation. There was no significant difference in each pair of zone 1, 2, 3 (P>0.05). The sensory score of zone 4 had no change after operation. The sensory score increased gradually from 1 week to 6 months after surgery. The incidence of NSD reached the highest level at 1-week after surgery (92.5%-97.5%), and it recovered to the lowest level at 6 months after surgery (15%~40%). At the same time, the algesia score was the highest in all sensations, and the warm discrimination score was the lowest. There was no significant difference between age groups or gender groups. But, there was significant statistical differences manifested between different methods of genioplasty, the time of exposure of IAN, the movement of distal bone fragment and the use of neurotrophic drugs. Conclusion: The accurate position of NSD after SSRO was the lower lip and the skin inside angulus oris. Algesia sensation recovered first, and warm discriminateon recovered at last. Genioplasty, exposure of  IAN, large movement of distal bone fragment were risk factors of NSD after SSRO. Nerve growth factor( NGF) can accelerate the recovery of NSD after SSRO.

Key words:  sagittal split ramus osteotomy, neurosensory dysfunction, inferior alveolar nerve； clinical study

中图分类号: 

• R782.23